The April 17th meeting of the county board of health to order.
 Hello, everybody and welcome 1st order of business. Here's approval of previous men meeting minutes.
 If we could do the March 20th.
 Meeting 1st, does anybody have any corrections.
 To those minutes, if not, I would yeah.
 I would make the approval March 20th. I'll 2nd all in favor.
 All in favor passes.
 Now, the special session that we held just to do a vote on 1 thing that ended up being 3 things.
 I know, right? Does anybody have any corrections to those minutes?
 If not, I, I will have them at like a meeting.
 I move that we approve. I will 2nd that motion too. All in favor.
 I that motion passes the, uh, the next item of business of public comment and we have a.
 Room full of the public possibly wishing to make comment.
 So, I am you each there's a limit of 3 minutes.
 Thank you. Um, if it's okay, we'll just go in order.
 Allison, and I think I signed them, but there's a part later in the meeting. Well, I get to speak.
 Yeah. So she is here for one recovery. So, so maybe she didn't go here after the comments.
 That is she's doing on my recovery. Okay, we will move your.
 Agenda item up. Do you have another public? Do you have a public comment to make on an issue? That's
 not line likely recovery. Okay. Then what I will do is we do need to get through the public comment
 1st, but I will move your agenda item.
 Up to the top of the next section so that we don't keep you here all night.
 Okay, Christine.
 My name is Christine, and I am a citizen and nurse of Monroe counties or until we get email that if
 the board of health, well, there was sufficient knowledge to be gained regarding futures family
 planning clinic. You all are full meetings about it.
 According to Indiana code 51431, all persons are entitled to full and complete information
 regarding the affairs of government.
 The demise of futures is a recent reflection of the mineral carry health departments oversight.
 So, the clinics last 3 staff members and representatives from Indiana family health council were
 not involved in.
 I'm here to share more insight regarding futures because it is also a cautionary tale.
 During a May, 2024 health board meeting, Dr. Pritchard described future staff as resistant to cross
 training and inference with their job descriptions.
 As the last LPN of futures, I recently obtained that my personnel file from county, which contains
 neither a poor performance review, nor a corrected action plan.
 Then I asked Dr. Pritchard and Lori Kelly to elaborate on which part of my job description I resisted.
 Neither of them provided a response to this request. Public records show that on May 30th of 2024,
 IFC president told Lori via emailed.
 There are several identified areas where the board has concerns about the futures family planning
 clinic, yet no one has approached us as the funder. I believe based on what is documented as a
 false misrepresentation of how we view the clinic.
 In July and August of 2024, public records show that Lauren was in conversation with health net
 about the possibility of having them take over title 10.
 Dr. Pritchard was CC'd on such emails. Lori did not inform future staff about such conversations,
 and I saw no evidence that Lori included IFC representatives.
 Before I decided to resign in August of 2024, due to worsening understaffing and increased
 expectations to absorb management responsibilities, I reached out to Aurora Dr. Ryder Band for help.
 In her response to my email, Aurora said that after consultation with Dr. Pritchard, board members
 will not have meetings with health department employees unless Lori is in attendance, claiming it's
 supported administrative communication procedures.
 Since then, a county attorney has informed me that they are unaware of any policy that would
 prevent health board members from meeting with employees without the presence of the administrator.
 In September 2024, I suggested that the Board of Health could strengthen connections with the
 experiences of public health workers.
 Instead, at the October AAR, health department leadership threw future staff under the bus.
 They acknowledged a need to increase regular communications with county counselors and commissioners
 only, not with health department staff.
 An open house for elected officials is something, but developing an ongoing rapport with health
 department staff could protect public health services for this community.
 It might also prevent more people from turning into Monroe County Health Department watchdogs and
 whistleblowers.
 It would be an act of accountability for Lori Kelly and the 2024 board members to acknowledge the
 details I shared today. Thank you.
 Thank you. Ashley Craner.
 Hi, everybody. Good evening. My name is Ashley Craner and I'm a Monroe County resident and I'm a
 former member of the Board of Health, which I served for 13 years.
 I'm here tonight for two different reasons. First, I want to show my continued support for Monroe
 County Health Department and the health board, but also its current staff and its former staff.
 I want to recognize and commend Christine for her ongoing efforts to bring transparency and
 accountability regarding the loss of futures, a program that supported this community for 18 years
 and was successfully managed with far fewer staff.
 Her questions have largely gone unanswered, echoing what happened during the last major leadership
 transition when we lost six long-term staff members when they raised concerns and were shut down
 and out by this administration.
 We are nearing 35, 40 employees that have either resigned or been terminated in the last couple of
 years.
 This is a serious loss, especially in this particular field where training, relationships, and
 institutional knowledge are critical.
 Let me be clear, as Christine mentioned, there is no law preventing the board from speaking with
 department staff.
 That's a choice that you all are making.
 Secondly, I'm here to express my strong objection to the changes and increased funding for the
 health director's position.
 As discussed at the April 8th county council meeting, the council has worked hard to build a fair
 process for classifying positions through PAC and through WIS.
 It has moved away from funding and grade supervisory roles for a reason.
 They were very problematic, very expensive.
 The idea that money equals better candidates will only hold if leadership can retain them.
 I seriously have concerns about that.
 I also intend to communicate those concerns in more detail with the county council and to any of
 you, if you may wish.
 Finally, when asked at the council meeting, what would happen if state funding is cut or reduced?
 Ms. Kelly answered essentially, well, I'm not going to get rid of people.
 I will get rid of programs.
 I ask you, what is the point of increasing responsibilities and pay for people if they aren't going
 to be delivering any public health program?
 I have a whole lot more to say on the current state of leadership, but I'm going to end with this.
 If you're tired of the constant criticisms, stop circling the wagons.
 Be accountable and do what's right for this community and the staff.
 Thanks. Thank you.
 Debbie Deckard? Hi, my name is Debbie Deckard.
 I don't have any things, anything written down, but I was an employee of Futures.
 I worked the front desk and came to understand and know our patients with a great deal.
 Dr. Pritchard, I was one of your patients for a long time. Kelly, you and I, Ms. Kelly, you and I,
 I always, I was always fine. I really had to bite my tongue when I got this.
 I had to request it. I wanted to request my file because it says I am not eligible to rehire part
 time, 24 hours a week.
 No, I'm not eligible for rehire, but I put in my two weeks notice. I had nothing, no write ups, no
 recommends, nothing.
 And I emailed Lori to ask you if I could please have a meeting with you.
 Lori emailed me back and said, no, I don't feel comfortable meeting with you.
 I have never threatened you, Lori. I have never came across negative. I've always been in your
 corner.
 And you know that. You could have had the deputy sheriff come in and sat with you or Eric or
 anybody else.
 All I want to do is talk about this. I don't like to do this stuff by email.
 And what rolls off my tongue rolls off my tongue. Then you said you've corrected. Then I got this
 one.
 I am eligible to rehire. How many others have you done this to that haven't asked for their file?
 I am still I have been one and I still have such compassion for our community.
 And I've tried to hold all of this in. I went back to school, went back to work for the school
 system.
 I was a nurse in the school system for eight years. I love patient care. I love our community, the
 community care.
 We got to know a lot of them. We all worked. Evan, Emma, the nurse practitioner, Christine,
 and I all worked together like a hand in a glove. Jane come in with patients.
 I'm wondering what's happened to her patients. Did they get the health care they needed?
 Because Jane spoke for them. I am the voice for our community.
 And I do want you to know I'm upset. Yes, future's closed. We all try to go on.
 But we need accountability. People have not left because it's time to walk out the door.
 They have left because things going on in this health office, and you know that, Lori.
 Dr. Pritchard, you need to be accountable, too, because you know this, too.
 And you guys can take a deep breath and roll your eyes, but you do. You know what's going on.
 And the board needs to be accountable just like anybody else, because it's not fair to our patients.
 It's not fair to me, because you know, Lori, when I had an interview with you,
 I was passionate about what you were interviewing me for, and this still hurts,
 because I still see our patients out once in a while at Kroger or out on the street.
 And they'll say, oh, hi, I remember you. I just love coming in and seeing you.
 And Gary, the homeless man, he would come in just so I could give him lollipops.
 Debbie, I'm sorry. I'm sorry, but your three minutes are up.
 Okay, that's fine. Thank you. We need accountability.
 Jane Walter.
 Good afternoon. My name is Jane Walter.
 I am a longtime resident of Monroe County and a former Spanish-English interpreter
 at the Futures Family Planning Clinic.
 I believe that the Futures Clinic was a public health treasure in our community,
 which was all too easily lost.
 I think that it is important to understand how our community lost Futures,
 which, as you know, was a federally funded clinic
 where truly excellent medical professionals and support staff served patients for 18 years,
 especially patients with limited funds.
 I want to thank those who have made comments today about transparency
 and accountability in our local health department.
 I do not want our community to lose other local public health treasures.
 Let's not throw out the baby with the bath water again.
 Thank you.
 Thank you, Jim.
 Is that it for public comment? Those are the only...
 I haven't signed in.
 Okay, you will need to sign in.
 It's okay, it's not a common one, thanks.
 Husted, Chris Husted.
 Thank you, Chris Husted.
 So my name is Chris Husted.
 Some of you may recognize me as the former clinic manager
 for Futures from 2015, January of 2015 to October of 2022.
 I don't have anything prepared as well,
 but I wanted to come in support of the previous staff members
 and also give my insight into my experiences with Futures
 and reasons why I left the Menorah County Health Department.
 So to give you a little bit of background,
 as you can see, I was with Futures
 for approximately eight years, almost eight years.
 When I came on board, I was able to increase revenue
 to be able to support a part-time person.
 When I came on board, the funding wasn't there,
 I was under penny, I was able to streamline the billing
 and bring a part-time person.
 That was very important because as it stood,
 staffing was severely limited.
 Clinic manager was doing the reception,
 was doing the billing, was doing all of the reports,
 doing pretty much everything except for the clinical side.
 And from the experiences that they have had
 where they did not have a clinic manager for four months,
 where there was not a job listing,
 I know how stressful that is.
 And to hear that I have heard something about cross-training,
 that they did not wanna do cross-training,
 and there is a significant difference
 between a temporary absence versus a four-month absence,
 and with no expectation for that to end.
 And so it does upset me to know
 that they were being penalized
 for something that was not sustainable.
 One of the major reasons that I left
 is frankly due to Lori's leadership or lack thereof.
 Anytime that there was,
 you would think that with almost eight years experience,
 that there would be some recognition of my expertise
 in a grant-funded clinic.
 But there were instances multiple times
 where I tried to provide my input,
 such as being able to order supplies,
 within a certain timeframe,
 because we have to in advance provide IFHC
 with that funding that in advance.
 And I was told basically stay in your lane.
 I felt it was very disrespectful
 and it was not something that I wanted to leave,
 but I felt that I had to leave at that point.
 Thank you, Chris.
 I understand we have someone online
 who would like to be heard.
 David Henry, if you could please, thank you.
 Thank you, thank you, Aurora and board.
 My name is David Henry.
 I'm a county counselor.
 I'm one of the two liaisons to the health department.
 I was calling in today on a different matter
 than what's been addressed in public comment.
 And I wanted to speak to that first
 before I go pine on what I just heard.
 I wanted to remind the Board of Health
 that as we're approaching the tail end
 of the state house session
 with Senate bill one passing this week,
 that the county counselors individually
 as well as collectively will be reaching out
 for boards and commissions and offices
 to really get ahead of our budget planning cycle
 as we're trying to negotiate cuts
 that we're anticipating for the next fiscal year.
 Which means that when we look at appropriations,
 forecasting and reversions from budgets
 to really make sure we're using all of our dollars well
 and all of our departments and boards on that.
 And so I just wanted to put that for you
 as we get ahead here into the fall.
 Secondly is a ask of all of you
 as you're having your meeting today.
 And I know that we have a position that we're reviewing
 and the health service director role
 before the next county council meeting
 that I think that based on some of the comments
 I've heard today about the futures clinic,
 we really need to find a close up this conversation.
 As you know, the health service director role
 was attempted to be merged
 with what would have been the futures director position
 last year that did not happen through the WISP process.
 I know that some of you are frustrated with our WISP process
 but as I've heard a public comment made,
 it is really the way we have to assure equity
 across director roles,
 not only in the board of health purview,
 but across the county,
 but to really come prepared to speak to some of the things
 that I've heard today as we review that second reading
 for that position.
 Of course, I would remind the board
 that under Indiana code 36-2-5-3,
 the county council has a unique shared governance
 responsibility with all of our boards and commissions
 to oversee fiscal oversight and making sure
 that we're expending our dollars well.
 In the moment I have at the end,
 having met a former public health employee
 in this department 20 years ago,
 having worked with NACCHO in my career,
 I think it's probably time for the board
 to consider releasing all the notes it has
 regarding the futures clinic closure to the public.
 There are documents that have been redacted
 that should perhaps shed more light
 on what we're hearing here and move on.
 It is not lost on me that the wound I'm dressed will fester.
 And I gotta say, I'd like to move forward
 as a community on this issue.
 I think we can do that together
 if we finally see some of the additional notes come to light.
 Thank you, and I look forward to working with you all
 on the budget in the future.
 Take care.
 Thank you, David.
 That closes the public comment portion of the meeting.
 Thank you all for coming.
 Thank you. - Thank you.
 (faintly speaking)
 Department updates, Lori.
 So I'll start with some updates with environmental.
 The county has received a total of 62 applications
 for the ARFA septic repair program.
 Four systems have been installed at this time.
 We have an additional 15 contracts that have been approved,
 and the goal is to have all systems installed this year.
 Wastewater is hoping that this type of program
 could continue in the future, but on a smaller scale,
 looking at trying to replace two to three systems annually,
 just on an ongoing basis,
 just because the program has had so much success.
 Foods is updating their processes
 to align with changes to the state code.
 I plan on having additional information in the May
 board packet and someone, either Mike or staff,
 that they will be providing information on those updates.
 Christina, our behavioral health and wellness coordinator,
 has completed PEARLS training.
 So PEARLS is an evidence-based program
 that helps older adults with depression
 create happier, healthier lives.
 The program focuses on problem-solving treatment
 and is designed to provide care for older adults
 with limited access to depression care.
 Essentially, once trained, coaches meet one-on-one
 with individuals for six to eight one-hour sessions,
 typically over a five-month period.
 Christina has also started conducting Tai Chi classes.
 So this is part of her KPI initiative
 to address trauma and injury prevention related to falls.
 She's also been working really hard
 on some food and nutrition,
 which I'll talk to you about later today
 with the Fresh Connect program.
 Aubrey, maternal child health coordinator,
 will be soon beginning her maternal nutrition program
 from bump to baby in collaboration with Purdue Extension.
 They're finalizing dates and locations,
 but looking at one of the libraries
 to be able to conduct those.
 The program combines education and cooking demonstrations.
 And at some point within the next few months,
 I'll have her be able to come to the board
 and talk more about that program.
 But we have been able to,
 we were looking at the Purdue Extension
 for some of that nutrition late last year,
 but we really were able to just come together
 and collaborate.
 They're going to partner with Aubrey
 on conducting the classes, do the cooking demonstration,
 cover some of the nutrition.
 She'll be providing education
 and we'll be covering program costs
 instead of going into an actual contract agreement with them.
 We currently have one disease intervention specialist
 job opening posted at this time.
 We are waiting to receive additional grant funding
 for an additional position if that is approved.
 And let's see.
 There have been discussions of changes
 to Health First Indiana.
 So some major changes,
 talking about changing the funding split
 to 90% of the funds to be used
 on preventative poor health services
 and only up to 10% on regulatory services.
 A waiver can be submitted by local health departments
 requesting to exceed that 10% cap.
 So I have reached out to the Indiana Department of Health
 if this does move forward to begin the process
 of being able to complete and submit that waiver.
 Additional changes to Health First Indiana,
 they're talking about removing public health preparedness
 and tobacco cessation from the list of poor services.
 And this would mean that Health First Indiana funds
 could not be used at all on those services.
 Lastly, the big one, discussions of mandating
 that Health First Indiana dollars be used
 on Indiana citizens only.
 So having a lot of meetings just to try to stay
 on top of all of that.
 The COVID supplemental grant funding
 has completely gone away now.
 There's currently some uncertainty
 of our standard immunization grant funding.
 Our next grant cycle would be set to begin July 1st.
 The award letter that was an anticipated amount
 was right around $30,000.
 In the state is saying there's just a lot of uncertainty
 about whether counties will receive that,
 less, more, and so that's something
 that's just unknown right now.
 Let's see, along with that a little bit though,
 we recently found around $67,000 of old grant funding
 doing some auditing going through our funds.
 So this dates back to 2021.
 So working on reaching out to the state
 to ensure that we can use those funds
 since the work was completed,
 even though the grant cycle has passed.
 We've also identified additional COVID funding
 negative cash balances from that time
 that we're working on making corrections
 and a grant dating back actually to futures from 2014
 that has some issues that we're working to correct.
 So hopefully once we get all of that straightened out,
 we'll still be in a positive
 with having some additional old COVID money
 that we can actually use.
 So that will help us through kind of this whole.
 Let's see, Linnea is going to be transferring
 to the Director of Public Health Preparedness Position
 May 19th.
 So she's still gonna be assisting
 with some of the duties currently being performed
 and there is a full-time administrative assistant job
 that has been posted and she's willing
 and going to help train that individual
 once we would find someone.
 So there have been discussions on posting
 a part-time environmental position.
 We're gonna kind of hold off on that right now
 until we have some more understanding
 about changes coming with Health First next year.
 The last thing I would say is I would like to ask
 that maybe we can start some of the conversations
 about contracts amounts in the budgets
 maybe at the next meeting just because come July,
 the state's gonna be wanting us to have that state budget
 to be able to submit to them.
 So maybe we can start thinking about it.
 I think at our next meeting,
 we will know a lot more about our financial situation
 and so we'll be in a better position
 to actually talk about those things in the next decisions.
 I also wanna congratulate Linnea.
 We don't wanna lose you though.
 We're excited for you, but we don't wanna lose you at all.
 Just as an aside,
 that's what you're talking about financing.
 I heard on the news last night
 that Indiana is going to probably have
 a $2 billion shortfall from what they expected.
 So yeah, I think we can count on our budget
 not being one of the ones.
 Laurie, I wanted to ask in your report,
 you were talking about the thing with Purdue
 and doing the Aubrey, how are we, are we, or can we?
 Three questions in one.
 Collaborate with the WIC programs.
 Oh, okay.
 Because to me, it seems like a natural partnership
 and we were just at a meeting with IU Health Community
 and I was talking about partnerships
 and I just think it would be good to work WIC in if possible.
 That's a great idea, I'll move on.
 Thank you.
 Any other questions or comments about Laurie's report?
 Okay, I would like to move an agenda item
 under old business, which is number five,
 limelight recovery to the top
 so that Ms. Greider may do other things.
 So I'm just gonna start.
 And I'm a co-founder of limelight recovery
 and last year I was able to come into the health department
 and did like a lunch and learn,
 talking about what harm reduction therapy is
 and what this evidence-based treatment looks like.
 Apart from what we think about traditionally
 with what harm reduction supplies
 and other health programs in our community,
 the treatment itself is I think where we're heading
 for substance use treatment.
 It's really about how the person sees themselves
 and with having a substance use disorder
 or their relationship to substances
 and it allows people to be empowered
 because of who they want to be,
 who they believe that they can be
 instead of identifying with the problem
 as like having an addiction.
 And so last year I was awarded with limelight recovery
 a $5,000 with the health first grant
 to do this group treatment in the local harm reduction
 organization to engage with participants
 and other members of the community
 who wanted to come in for this treatment
 and it's a 12 week group and it was amazing.
 We used all the money, we've been doing group.
 Now we've added a second day a week
 where we're trying to get more participants.
 And this year you all have approved
 for us to also include an individual program.
 So we're going to be able to,
 and I've already started meeting with people
 even before the approval.
 So it's amazing to know that this can continue to go on
 for people who don't have insurance,
 for people who are losing their Medicaid.
 It's happening a lot with many of our clients.
 But so this individual program will include 10 sessions
 and we'll have a mental health
 and substance use evaluation and then can engage
 in individual therapy, family therapy.
 We're working with two different people
 who are finishing up their peer recovery certification,
 hoping to add that into the mix
 with what we can offer folks and also case management.
 So we're really able to kind of lose some of those barriers
 that keep people from accessing care
 and really provide them with what they need.
 If that's like case management with getting other services
 in the community or if that's working on like the safety
 inside themselves, like dealing with mental health issues
 and a chaotic relationship with substances,
 that can be the hardest thing,
 it's just being alone with yourself.
 And it's really a privilege to get to like work
 with this population.
 We have people who are unhoused,
 we have people who are employed at different,
 like at the Harm Reduction Organization
 who are engaging in this service.
 And then we also at Limelight Recovery
 have a partnership with Marion County Probation.
 But just in the last year,
 Monroe County has reached out to us
 and wanted to start sending us some materials as well.
 So it will be an option now
 for a few at least mandated folks
 who have to engage in some kind of treatment
 to get this most evidence-based progressive way
 of seeing themselves in their relationship with substances
 and they'll have that opportunity
 that they're going to have to do anyway,
 but we can provide it for them without it,
 creating more barriers in their lives financially.
 So it's incredible.
 And I know you had a question
 that I responded to via email,
 just wondering what the percentage of people
 that might be from the Probation Department.
 And I just wanna reiterate that I'm hopeful
 that we get like a really good balance
 of different people,
 like people just hearing about this programming community,
 people who are participants of the Indiana Recovery Alliance,
 who may be continuing to use substances
 but are feeling safe enough to actually meet with someone
 and be honest and evaluate that relationship with drugs
 and see what changes they might want to make,
 or even just work on their trauma or whatever,
 to have that opportunity is huge.
 And then, yeah, anyone else that hears about it
 from the community, I've put some flyers up
 and spoken to some people.
 Groups recover together,
 the Medication for Obesity Disorder Clinic,
 and we also have a peer mutual support group too
 that's like separate where it's kind of like AA or NA
 but uses that harm reduction lens.
 So we're really like doing so many different things
 to meet a lot of varying people's needs
 all within, you know, housed in the Indiana Recovery Alliance.
 So it's really exciting, really beautiful
 to see the spectrum of care that is taking place there.
 And a lot of that is because of you all believing in me
 and allowing this program to grow.
 So I didn't prepare, like I didn't know exactly.
 I was like, I wish I would have looked at the numbers
 last year. - It's good.
 We appreciate the update.
 Thank you.
 It sounds like you're doing great work
 and we're happy to support it.
 It's important for citizens of Monroe County.
 So thank you for doing that.
 Thanks, Alison.
 Any questions?
 Alison, do you have a sense at all
 of any kind of recidivism rates in your program?
 This is something that actually Laurie and I
 have talked about, like getting together
 and how to do some more research around it.
 And when it comes to this model,
 it is a bit different because the metrics
 are not like return to use.
 It's more of like quality of life improving.
 And so I think we might have a better idea
 with the individuals who are coming
 from the mandated side of like,
 if they end up having a return to use
 and if they're re-referred into some kind of treatment.
 So we might be able to see it a little bit better
 in that regard.
 But when it comes to like the values of this model,
 I don't have a lot of data.
 The other question I have for you is in this model,
 is there a place for family therapy as well?
 Yes, and I hope I mentioned it,
 but family therapy is also part of that.
 That we can, again, it'd be nine units after their intake,
 like their assessment.
 And if that is one of the main areas in their life
 that was disrupted based on their relationship
 the substance is we want to do family therapy,
 which is incredible that that's part of this grant.
 So I'm really hopeful to bring in the children,
 bring in the parents, bring in the partners
 and have that space to talk about how to support this person.
 Also how to like mend things that have occurred
 and really wrap around the person and support them.
 And not with that shame that I think traditionally
 in like accidents only programs not intentionally give
 but it comes with that.
 There's a lot of internalized shame.
 There's a lot of different rhetoric about enabling
 when it comes to loved ones.
 And so we really want to, I guess, kind of change
 the language and figure out how to like radically love
 these people who are hurting and going through this
 so that we can continue to like prevent death
 and loss of family and community.
 I don't think you're also just trying
 to build self-esteem in the process.
 Yes, yeah.
 Thank you, it's so great to have you in community.
 Yeah, we're really happy you're doing this work.
 Thank you so much.
 Thank you, thank you for coming.
 Cool, we appreciate it.
 Anything else?
 No, thank you.
 Thank you guys.
 Nice meeting you.
 Okay, so under old business,
 then we're going back to number one.
 So we're coming back to IHI that we talked about
 at our last meeting.
 And I think the only question,
 at least the only question I could find on minutes
 that we needed an answer to before we could vote
 on whether or not to pursue the contract
 had to do with what Monroe County's IT folks said
 about the confidentiality of the data.
 Do you have an update for us on that?
 Yes, so our Director of Technical Services Department
 back shared the information with him that has been reviewed
 and we are all could you get an offer about.
 So the only other question I had was,
 if you're looking at it from a patient standpoint,
 if my data is in your database
 and we know it's safe technically,
 do I know if it's being used in a research study?
 And have I given permission for my data
 to be used in research study?
 Because they're not gonna be looking at aggregate,
 they're looking at individual people's names,
 addresses, phone numbers.
 That's pretty personal stuff.
 And so I think we mentioned this to her,
 she was gonna ask whether or not,
 if there was research being done using our data,
 whether our patients had an option to opt out or opt in.
 I never heard the response.
 In terms of patients, we don't really have patients.
 We will, I mean, we may, yeah.
 D.I.S. have patients.
 That's it, we don't operate any clinics.
 Except for the work that the disease intervention
 specialist might do.
 We don't have--
 Do we give vaccines to people in our clinics?
 That's healthcare.
 Well, they use paper.
 We don't really.
 Yeah.
 It's community health.
 So this program here would be used with our D.I.S. program
 just to essentially try to speed up
 when they're trying to find out.
 They would be going to search and look for records
 and information.
 On individual patients?
 Mm-hmm.
 Yes.
 And that's the data we're going to be shipping to them
 that they're going to share with Regenstrief,
 which is a research facility.
 So my concern is if it gets passed from there to there
 and there to there, is my patient, is me and my still
 protected if it's used in a research project?
 I have not heard from--
 Yeah, so we answered the technical problem.
 Yes, technically we're good.
 The other problem we have to have,
 we would have to hear from--
 They were going to get back to us about
 how would we use in research
 and how we would protect them from being exposed.
 And another piece of that is when they sign up,
 or rather when they become part of that program,
 do they sign a HIPAA waiver?
 I mean, I assume they do, it's their private information.
 And so the HIPAA waiver, we need to be able to look at that.
 It needs to say that they have the option
 and what recourse they have to opt out of their data
 being shared, or their specific individual data
 being shared with an organization,
 because that's part of, that's part of HIPAA.
 But our situation is no different than all of the data
 that's currently going to Registration.
 It's just adding to it.
 That's currently collected by every healthcare provider,
 but we as a state.
 So when I was in IU Health,
 and my patient's data was being used,
 it was going through IHI for the purpose of another provider
 to be able to see what I did.
 And then when she saw the patient, she knew what I did.
 But on occasion, they would send me a special form
 saying your patient is going to be in a research study.
 I had to go back to the patient and say,
 are you sure you want me to share your data?
 So you were given, you as the healthcare provider
 were given--
 I was notified.
 You were notified and then the form,
 whatever form you got said your patient
 has the opportunity to opt out.
 They had to be made aware that their data might be used.
 Okay.
 So it's good that that system is already in place, right?
 Well, that's why you held.
 And it's working.
 Not here, but eventually, we may be seeing patients here.
 We may, our focus may change.
 And we may have a futures clinic in the future.
 I don't know.
 I mean, something like that.
 Where are, we do have any patients in there.
 So I just have to advocate for the patients here.
 So we would need, it sounds like we would need to find out
 under what circumstances are we having,
 are we providing those things for people to sign?
 Back to another meeting.
 Well, you know, what we might do,
 just a suggestion is if that question was answered
 in a satisfactory way,
 would we be willing to vote yes on this?
 I think so.
 So we could provisionally accept this.
 If we want, if it's the will of the board to move forward,
 pending the correct answer, you know,
 that the answer that would satisfy,
 which basically just means,
 does the patient have an opportunity to opt out?
 I mean, that's basically what we're asking, right?
 I don't feel like it's a check the box, yes, no question.
 I think it's a discussion.
 So I think it would be hard to, I don't know.
 I think it'd be difficult to,
 maybe Julie can just come speak to us
 at the next board meeting or...
 So one way out of this is to say,
 they can only use aggregated data.
 So they can look at a big picture thing,
 how many people in this county had this disease or whatever,
 but they want individual data.
 They're asking for something very, very different
 than aggregated looking at population health.
 And you're talking about,
 the example that you're talking about
 is a specific research study.
 It's not the situation where one of our workers
 has to find somebody or understand
 what their test history is,
 so they're gonna look at data.
 So I, you know, if they were gonna,
 let's say the study was gonna involve
 40 to 50 year old women who are Caucasian.
 They would, their computer would just pull up a list
 of all the women who are 40 to 50 in the database,
 and then that's their data set.
 And so, you know, if one of my patients gets in that data set,
 they have a right to either not be in it
 or to at least know what their data's being used for.
 So we're gonna be in that position.
 You know, I think IHIE is not the same
 as a big aggregator of data.
 It's a, it gets down to the nitty gritty,
 and she can look up my patient's hemoglobin last month
 and it's there, even though I ordered it.
 Right, right.
 I mean, that's fairly granular.
 And so when you get to that kind of data,
 it's treated differently than it is aggregated.
 'Cause you can go back and find that person.
 So do we wanna table the entire thing again
 until next month and ask Joe to come back or?
 I'll defer to these two because they're treating patients.
 So you know, whatever they decide.
 I'm okay with it, except for that.
 That's the only thing that I had a concern about personally.
 Or do we wanna do Steve's idea of the provisional?
 Yes, we'll approve it if we get confirmation.
 I would like her to come and address the board
 and so we can have our conversation about it publicly
 and then we can vote on it right away at the next meeting.
 I think we give her some guidance ahead of time.
 And you know, our concern is really
 patient confidentiality once again.
 It's not just, is the system safe,
 but is the patient aware that their data is being used?
 Do they have any say over their own data?
 I just wish as a procedural or process
 that we would have stated these two questions,
 which are separate questions.
 Last time when we tabled this idea, we did.
 We did, she was asked that question.
 Because I did not see that in the minutes.
 All I saw was the IT.
 I can't find the minutes.
 Okay, very good.
 I'll certainly remember sharing the-
 Board members expressed concern with patient privacy
 and confidentiality, and Mr. Schilling advised,
 confirming with the county tech and services
 that those data safeguards are sufficient.
 Yeah.
 But that's not privacy and confidentiality.
 Yeah, I agree with that.
 That's not privacy and confidentiality,
 and that's to prevent hacking and things like that.
 That's what you want to say.
 It's information, Julie.
 Yeah, and look-
 This has to do with HIPAA, what's-
 The IT, the IT portion.
 So there's nothing in here about the situation
 that you got up, right?
 So HIPAA, but this is not HIPAA.
 When you start doing research,
 this is under something else.
 This is under Investigational Review Board,
 and I asked her if they had an IRB,
 she said, "No, but you have to have an IRB
 "to do research on human subjects."
 Well, they don't need to have the IRB.
 The researchers have to-
 If they're selling the data to Reg and Streeve,
 Reg and Streeve needs to provide-
 So essentially, there's actually two issues.
 We're getting a little off topic.
 It's not off topic though, I feel.
 So there's really two questions that we have to answer.
 In HIPAA, are the patients having to sign a HIPAA agreement?
 Then in the HIPAA agreement, you have to have
 that the patients agree to having their data in an exchange
 where their individual data can be looked at.
 And then the second, is that true?
 And then the second issue is if IHI doesn't have an IRB,
 but then they're selling the, or rather,
 giving the patient's data in this way for a research study,
 then those safeguards are not in place
 and we need to be aware of that to make decisions
 about how we proceed.
 Yep.
 So the gal, her name is Julie?
 Well, surely these issues have come forward from other--
 Yeah, I imagine this is other--
 The difference is she's, I mean, we can't actually--
 We can't be the first people in front of this.
 No.
 Just had this discussion with them actually
 as a private practitioner and so this is a real concern
 with IHI.
 Oh, okay.
 Usually it's just IHI, now we have a third party.
 That's the problem is the third party
 that they don't have control over
 that's gonna be getting our data.
 It's not IHI.
 It's not them, it's the registry.
 Do you understand all of that well enough to ask Julie?
 Well, I was gonna ask if somebody could write
 the questions out, but if she's gonna come,
 then I've asked a question.
 Yeah, just tell her that we still have privacy issues
 because the data is being given to a third party researcher.
 And the good news is we have it on recording.
 So we know what the issues are.
 Hey, good, thanks for reminding us.
 Okay, so we're gonna table this until next time.
 We're going to ask Julie to come speak with us
 at our May meeting.
 And maybe legal, maybe she has her legal, somebody.
 And he also, our lawyer, makes some comments
 that he was gonna look into, not just HIPAA,
 but the second part, right.
 The STD peached grant amendment
 to add the additional position to cover the counties
 no longer covered by Marion County District 5.
 Yes, so this is pretty basic here.
 So originally when we agreed to take on
 the additional four counties with the new grant,
 the plan was that we would have three
 that would be grant funded,
 and then we would have one that would be funded through HFI.
 We'd already previously had one position providing services
 just in Monroe County that was HFI funded.
 So that was kind of the plan that I had in place.
 I was contacted by our council liaison, David Henry,
 and he had requested that I ask the state
 for additional grant funding to support all four positions.
 So I did reach out to the Indiana Department of Health
 making that request.
 They graciously agreed to that through just a virtual,
 asked me to submit a budget revision,
 which you'll see there in your packet, which was submitted.
 So I'm just waiting on the new grant to come,
 but if you're...
 So you would be approving this additional funding.
 Once the amended grant comes,
 then I would be able to provide an update
 and take that through
 just our normal counting processes for approval.
 Does anybody have any questions?
 If not, we can make a motion.
 I move we approve.
 Any additional funding?
 Second?
 I'll second.
 All those in favor?
 Aye.
 Opposed?
 Lisa, board priorities update.
 Yes.
 So we decided to stay with two priorities for the board,
 which is chronic disease management,
 including obesity, diabetes, and hypertension,
 and addressing vaccines, specifically measles vaccination,
 given the recent increase in cases.
 And unfortunately now there were cases in Indiana,
 but not here as yet.
 So we had a, the state came and did a mobile unit vaccination
 clinic, and Linnea has been great about giving information
 on social media and updating the public.
 I would like to see working further and talking about
 keeping this conversation open so that people in the
 community know what to do with their,
 if they think they have it or exposed it,
 where to go, et cetera.
 I attended the vaccination clinic and talked to some of
 the people and they said they had eight people show up.
 And what they really needed was to go to seven Oaks and
 some other private schools where they were concerned that
 that was a bigger need.
 Will they be able to get in?
 So that was my question.
 That's one of our other things today we're gonna talk about
 is this MCPHC update is it mentions that they cover MCCSC
 and RBV, but do we cover other schools in the county that
 are not public?
 Or a vaccination clinic?
 Or anything?
 So it's offered to the schools.
 Some of them take up the interest of some of that support
 and some of them do not from my understanding.
 Are we offered to all?
 Yes.
 Okay, good.
 What is the vaccine clinic in the 21st and Ellsville?
 Say it again.
 There's an MMR vaccine clinic set up for the end to six
 in the 21st at the Ellsville.
 Ellsville, yeah.
 I'm gonna be going to that one too.
 Give 'em some support.
 It's hard to sit there all day and give eight vaccinations.
 I think they ended up doing,
 I thought they ended up doing 15.
 15.
 And the last one.
 And just to revisit the chronic disease management
 and impact for the community.
 I think as a board,
 we're again gonna be under budgetary constraints
 and I think we need to utilize the folks
 that we have in place to be doing this important work
 and gathering data.
 I think Christina in our health department
 and then the clinic on Miller Drive.
 And I think that we as a board need to push
 to get data as we talk about data,
 just the individual blood pressures, et cetera.
 And then getting pushing IU,
 we have these contracts with them to get us KPI related data
 and really pushing to get that information
 so that we can give that to the public
 that we're making an impact.
 All right, Beth, questions, discussion, anything?
 Thank you very much, both of you for your work on it.
 Open house planning.
 Is anybody doing anything with you?
 Are we gonna have some refreshments?
 Are we gonna, we did the slides.
 Thank you, thank you.
 More slides need to be done.
 These guys are working on more.
 I'll put together a couple more.
 We need to, I guess.
 So, I know you're doing slides.
 Diane and I, Diane and I worked on it together.
 We got the help of Kathy Hewitt
 because she had done our 82 page thing anyway.
 And so she knew it back and forward.
 And so she picked out three that were pretty aggressive.
 They talked about what we did, who we asked,
 and then what they said, basically.
 So that's what we're responding.
 Sarah and Lori are going to put together
 a couple of slides on HFI to explain
 what's going on with them.
 So what I'm thinking is we talk about HFI,
 we talk about the community health needs assessment,
 we talk about the priorities that stemmed
 from the community health needs assessment
 and what our plans are.
 And any other content that you guys feel
 needs to be presented to council or commissioners,
 I don't want it to be overly long.
 You know, I'm gonna keep their attention.
 But I want to just give them a snapshot
 of what we're working on that maybe they didn't get
 from meeting with the individual departments
 when they walked through.
 So more of a board kind of perspective of,
 you know, here's what we're working on.
 And to me, the HFI stuff captures it well,
 the community needs assessment,
 our priorities that we're gonna focus on.
 Is it too touchy to talk about
 the effect of this memorandum with them
 because they're the ones who voted.
 So the memorandum basically says the county
 does not need to do a levy as in previous years
 because of the money you're getting from HFI.
 And the intent of HFI was to grow public health
 because we're 49th in the country.
 And yet they're falling back the money
 that you got from the state.
 Is that an effective?
 Here you go.
 Because I would say, I see it.
 Thank you, thank you.
 Yeah, I mean, maybe that's too touchy a thing
 to talk about, but you know.
 I think it's a fine thing to, I mean, I would go for it.
 What do you all think?
 Yes, so this would, so can I ask you guys then
 when you're doing your HFI slides to work this in
 like as an informational, oh, and you understand
 from the December 4th memo that blah, blah, blah, blah,
 things, understand this is not the intent of HFI
 and it will work to decrease the attainment
 of those health outcomes.
 Thank you for pointing that out, I haven't read that yet.
 Yeah, I mean, I've seen this before, so.
 The amount of money they're saying of course, you know,
 that the $681,000 distribution of property tax
 of that nearly 1.6 million cash balance fund
 and that 681 is close to what we typically got from it,
 wasn't there, or did they give us nine?
 Nine, but previous to that, it was over 1 million.
 Yeah, and plus they use this term,
 and once the cash balance is spent
 down to an appropriate level, what does that mean?
 I mean, we should be 50% higher than we are
 if we wanna be on the average
 with county health departments in the United States,
 we're way, we're at the bottom, we're 49.
 We don't have ways to go to even be average.
 So I think they have, you know,
 whatever this appropriate word means,
 I don't know what that means.
 I don't think they know what appropriate is
 for public health to grow.
 I think you give the floor to a council meeting.
 You just talked to yourself, Mr. Councilor.
 And I love the idea of right sizing.
 It says, you know.
 Yes, to right size the apportionment.
 It's really sad.
 On the other hand, we also know that the state
 is in financial trouble.
 And so is the county.
 So obviously to me, it looks like everybody is trying
 to scramble and that once again,
 and it's part of what I've suggested before
 of our making a point, perhaps.
 And I'm not advocating any actions.
 However, it'd be really great
 for board members periodically to show up at council
 and make it clear to the public
 who may not be watching or listening
 what the diminishment in funding
 to the health department means for our future as providers.
 And that it is council, again, that holds up our funding.
 That we may have all this money in our balance,
 but if they don't release it for our use
 in the ways that this board determines
 are in the best interests of the public,
 then, you know, yeah, we'll keep having a high balance,
 but we won't be able to provide the services
 that this board determines.
 And I think the other thing that worries me
 as your health officer is that, you know,
 the health board is indeed, as any board is,
 fiscally responsible to the public.
 That's the action of any board.
 And so for council to say, yeah, but we have final say,
 well, that's true, but it's still our money.
 And what is the point?
 And maybe I'm just terribly naive,
 what is the point of having a health board
 that looks at the budget, examines the budget,
 determines piece by piece what goes into the budget
 and how our personnel are distributed
 if we're constantly fighting against council.
 And again, I'm new to this position,
 but I have a really hard time understanding
 how that works.
 I hope that when we have our open house
 that we have a little time to speak one-on-one
 with a couple of the council persons,
 'cause I certainly, you know,
 we never really have a chance to talk
 except in formal meetings.
 And I think there's, and that's for good reason,
 'cause we want the public to be aware
 of what's happening in our government.
 But it would be nice to have a couple of frank conversations
 and find out exactly what their expectation is,
 what they'd like to see happen,
 and to see how we can make those things happen
 without having to reduce services
 in view of what our constraints are.
 So I have some high hopes that they'll have some time.
 It's kind of why I want our presentation to be short
 so that, and to have refreshments,
 because usually if you feed people,
 they tend to stay around and talk a little bit.
 So will there be a problem getting somebody
 to get some type of refreshments at hand?
 Do you have anybody that can work on that?
 Do you have a party plan in your sleeve?
 We can certainly have refreshments.
 How are we paying for them?
 I guess, but--
 Do we have anything in the budget for that?
 We can't use it.
 I'd be happy to make a donation.
 Yes, we will do that.
 So I guess we'll do a pension party plan.
 Is there a board member who would volunteer
 to be responsible for collecting money and possibly--
 Well, we can decide what we want
 to find out how much it's gonna cost
 and then we can figure it out.
 Okay, so between now and next Friday,
 to get figured out, which is what I'm saying,
 I would have--
 Okay, we'll talk about what we want to have.
 Directly following the meeting, how's that?
 We'll talk about what we want to have
 directly following the meeting.
 Yes, we'll do an executive session.
 Another question that I have, I wish Dave were here,
 and maybe you all know, okay.
 Do we need to advertise the open house under open door
 since we're all gonna be here
 and then council and commissioners have to do the same thing?
 Yes. - Okay, okay.
 So just making us all aware of that.
 And is it possible for you to have someone in your office
 do something a couple, well, a couple days before,
 maybe phone call them or email them
 or some type of reminder,
 we're looking forward to seeing you at the open house,
 please be sure to come.
 Yes.
 'Cause I think that would help a ton.
 Food and beverage, right?
 Food and beverage, right?
 And we won't lecture you too long.
 Yes.
 Thank you, thank you.
 Any other thoughts about the open house?
 So we're gonna show those slides on,
 we're just gonna show them one time to the whole group,
 or are we gonna have them on kind of a,
 where it rotates and just continually plays?
 In my head, it was one of us or several of us
 would do a PowerPoint presentation
 and speak along with the slides.
 So simply.
 Stinctly.
 (silence)
 New business.
 It looks like we have to vote on Fresh Connect
 and the HIV Prevention Grant Award letter.
 Yes, so the Fresh Connect program
 is one that Christina has been working on developing.
 She did create a PowerPoint.
 So I don't wanna, I'm gonna try not to take up
 a whole lot of your time with this
 'cause I'm sure there probably will be some questions.
 But she did do a really nice job on the PowerPoint.
 So just to kind of start off here.
 So we do as part of Health First Indiana
 need to have a program that is focused
 on addressing obesity.
 And since we are working on trying to address
 chronic disease as well and increasing access
 to fresh fruits and vegetables,
 this is really just, I think, a pretty exciting opportunity.
 Wow, that's kind of hard to see.
 That is really hard to see.
 I could walk up there.
 Okay, you think that's better?
 That's better, yeah.
 Yes, so we would, we have been talking with Health Net.
 So typically this program is designed
 that local health departments are working
 with a health provider.
 And the health providers are providing care.
 Health Net does already provide screening
 to identify food insecurity.
 But essentially, it's really to be able
 to help cover some of those gaps.
 Let's see, I'm gonna move.
 So eligibility requirements for this program
 in development with Christina,
 this would be for Monroe County residents.
 And they would have to be identified as an eligible client.
 So Health Net as the provider,
 so someone who has food insecurity,
 and then is diabetic, high cholesterol, obesity,
 hypertension, or for their maternal patients
 in need of access to fresh fruits and vegetables.
 So Health Net would be identifying these individuals,
 essentially prescribing them this service,
 and then referring them to us to be able to work with them
 on setting up the program and the enrollment.
 We would be capturing data as well as Health Net.
 So part of the agreement for individuals,
 they would have to be willing to provide baseline data.
 So weight, their cholesterol, A1C, blood pressure screening,
 so enrollment, and then a three-month period with Christina,
 and then at a six-month period.
 Any information that Health Net is gathering
 as far as data, they would be able to share with us
 kind of in those gaps in between.
 Some of the administrative details,
 there is a one-year minimum commitment with Fresh Connect
 and 150 individuals or whatever the lifetime
 of the program is that you use.
 The goal was to be able to start the program in June
 and ideally have 150 enrolled in December,
 and then be able to translate that into next year.
 I guess that kind of gives you a breakdown there
 of some of the information I just went over.
 So I have spoken with our IT department,
 we're good to go on the privacy side.
 It is a HIPAA compliant platform that we would be using.
 And yes, sorry, information about just programming.
 And so the cards are loaded at the first of each month.
 And funds, if any funds that are not used
 do not roll over to another month and we are not charged
 for those that typically rolls back into our account.
 And the Fresh Connect program,
 once someone is enrolled in the program,
 they actually contact those individuals
 to explain the card, explain how they should be using it
 and are there as a support system
 for any troubleshooting or issues that arise with the card.
 Can be used nationwide here.
 Looks like a credit card.
 You can use it at Walmart or Trover.
 Again, just as long as it's only limited
 to fresh fruits and vegetables.
 They are working on expanding the program
 to be able to start including some frozen fruits
 and vegetables and that's something that they're working on.
 But right now this is just limited to produce.
 They work with food banks too or just with Trover and?
 Trover and Walmart. - Walmart, that's it.
 That's what we do.
 There's a map that you can look on online
 but those are the ones that we saw.
 Let's see.
 So able to address any additional language needs
 as the clients support.
 They do engage in reminders.
 If someone has not used a card within 30-day period,
 they will attempt to contact the individual
 to kind of figure out some of the reasons why
 and work through that.
 And that just kind of, this breaks down some of the costs.
 So there is a $5,000 annual administration fee.
 There's some support fees.
 I thought they said 10.
 But we're a government agency.
 So there's a different reduction in a rate for that.
 Thank you.
 So what we were thinking of and we've talked to
 Marion County and some other individuals,
 single individuals offering them $50 per month.
 Individuals who could be considered either a single adult
 with children or two adults offering them $80 per month
 on the card.
 Yeah, I saw something in there that said you could tie it
 to Medicaid enrollment and other things,
 which I think is a really bad idea,
 because with so many people losing Medicaid,
 you don't want to also shut them out of other programs
 because they're not Medicaid.
 Right.
 Let's see.
 So it's just some estimated costs here.
 If we had all 150 participants at that maximum $80 for six
 months, so the range, so minimum and maximum,
 we're looking at roughly 61,000 to 88,000
 if the individuals were using the full amount
 that's loaded on their card, depending on single or family.
 And if we do it for six months,
 do we have to continue or can we do it for six months
 and see how it works and then not in the red?
 So it's a one, it's a one year.
 So our goal was if start in June,
 get your 150 enrolled by the end of the year
 to get them cycled through that one year.
 We can essentially, we'll be piloting that then
 to know whether we want to keep enrolling.
 Thank you.
 There's gonna be a whole year commitment.
 That it is with the Fresh Connect, yes.
 So the 60 to 80,000, would that be the contract amount
 basically that we'd be building on?
 For six months, it would be twice that, right?
 Well, so you'd be voting on the contract,
 but then yes, that the, whatever the,
 because we don't have an exact dollar amount.
 So whatever the associated fees are then with the contract,
 but those, that's the maximum amount for all 150.
 And so we'd be kind of,
 and I've done it a couple of ways with budgeting
 for this year and then how many for next year.
 So I would be allocating funds in our next year's budget
 to make sure that we have that set aside.
 That was my next question,
 we do have the money for this, right?
 Yes, yes.
 And-
 It's going to the money while we have the money.
 Yes, and I will say that was brought up
 on a meeting today actually,
 that if you're thinking about holding on
 to a lot of your funds as a cushion,
 you better use them because they could.
 Yeah, yeah, well, yeah.
 And I'd rather get something in place.
 So the 90,000, roughly 90,000 that we see for six months,
 that, does that include all of those fees?
 Yes.
 As well?
 Yes.
 Other questions?
 Well, I think the only thing that I find that's,
 yeah, this is great.
 And I guess I'm glad that the city doubles people's SNAP
 so that they can get fresh fruits and vegetables there.
 So they basically, if they have SNAP already,
 they may get more than...
 Well, SNAP disqualifies them from this.
 It's their own SNAP.
 Well, so Christina, we have talked about trying
 to focus on those individuals first
 who don't have any eligibility to be,
 but who still are maybe just over that amount,
 but still need help and assistance
 and try to capture those populations.
 And then we can kind of expand it from there.
 And I hope that in the process that they're also steering,
 if the people don't know about it,
 places like Mother Heaven's Cupboard
 where they can get healthy foods
 that indeed supplement what this allows them
 and also get some training in how to cook this stuff
 and what to do with it and how to manage.
 So part of the welcome package when the referral comes
 and we are getting the individual signed up.
 So Christina would be developing a welcome gift
 that has like some recipes
 and these are the types of foods maybe
 that you should look for.
 And these are how to prepare that
 and some of that education that's also tied to,
 if this is your condition,
 maybe focus on these types of meals and foods
 to try to build in some education with it.
 Related question, how does this play into any interaction
 with WIC, the farmer's markets, purchasing programs
 and things, I guess the credit card will work
 more than the farmer's market.
 All right, from my understanding,
 there's kind of a different program called Fresh Box
 that are targeted for--
 (indistinct)
 And I guess because they are meeting
 with IU Health Community Health Israelis,
 still in my mind, are there any opportunities
 for collaboration or partnership that you can see here
 so that they can have a role?
 Like, I guess I'm thinking hearing them talk
 about nutritionists, sure they have nutritionists on staff,
 maybe they could have someone do a cooking class
 or talk to people about if you have this condition.
 There's a lot, 'cause sometimes people receive information
 and then don't read it.
 Yeah. (laughing)
 So I guess I would just say,
 ask Christine, investigate those
 collaborative relationships.
 Can I ask one other?
 It looks like David really is up there, right?
 Just turn yourself.
 I just, I wanted to ask whether, if it passes
 and indeed our HFI funding can only be used
 for our U.S. citizens, how will this impact the program
 and will it end, will we just say,
 hey, of course that there are U.S. citizens.
 Of course there are U.S. citizens.
 I just thought I would ask
 because it was one of the ugliest things that I've seen yet
 in the bills that are coming forward.
 Dave, did you want to say something?
 Hi, Dave.
 I had just something to say about the IHI contract.
 When you get a chance.
 Well, we weren't going back to it,
 but we'll go back to it again.
 What did you want to say?
 Well, I just started scrolling
 through the terms and conditions and on page 21,
 it says conditions for disclosing
 individually identifiable health information.
 And it says that if that's going to be used,
 that there has to be a disclosure agreement
 obtained from the individuals.
 I mean, let me just read it,
 'cause if PHI is requested for a research project,
 Regenstrief shall not use or disclose the PHI
 unless authorizations that comply with the privacy rule
 allowing the use or disclosure of the PHI
 for the specific research purpose
 have been obtained from all individuals
 whose PHI will be used or disclosed.
 I don't know if that addresses your concerns.
 It seems to totally address the question, doesn't it?
 Yep, I didn't see that.
 Okay, that's why you're a lawyer and we're not.
 Thank you.
 Look at all those details.
 Sorry, I didn't get to that earlier.
 Thank you.
 Do we wanna circle back then to the IHI contract?
 Okay, hang on a second.
 Let's do Fresh Connect first.
 I need a motion on Fresh Connect
 and let's hop it up here first.
 I would move that we move forward
 with the Fresh Connect program.
 And I would second it.
 All those in favor?
 Aye. - Aye.
 All opposed?
 Okay, Fresh Connect is okay.
 Let's go back to IHI.
 I would like a motion.
 Given the new information we received,
 I would move that we approve the IHI contract.
 Is there a second?
 Second.
 All those in favor?
 Aye. - Aye.
 All opposed?
 Aye.
 Thank you. - Aye.
 What are you?
 I am opposed.
 Okay. - Yeah.
 Okay, so one, two, three, four.
 Okay.
 Approve HIV prevention grant award letter.
 So this grant supports the salary expenses
 for the harm reduction specialist there.
 This will just cover salary and fringe.
 They pretty much just said that funds were tight with this,
 so we're happy to see that they granted us this amount.
 The grant cycle will begin here in June.
 And so once we receive that grant,
 I will just take it through the normal county processes
 with the board's approval.
 Can I get a motion?
 I thought I've read that it was tabled or something.
 The DIS, so that's a different grant.
 So STD, shortening prevention is tabled.
 So you're asking for him.
 I'm asking for a motion.
 Okay, so moved.
 You're a second.
 I will second that motion.
 All in favor of approving the HIV Prevention Grant Award,
 say aye.
 Aye. - Aye.
 All opposed?
 Thank you, that carries.
 Board member and health officer comments.
 I have a lot, but I wanna open it up 'cause I'm talking.
 Hey, one thing I noticed that was in our packet
 was the communication drill that was done
 within the department.
 That was really neat and done in 30 minutes
 and I wanted to compliment them on that.
 But eons ago, we also had a tree set up
 or a bone tree for the board
 in case of emergencies and so forth.
 And I just wanted to bring forth that to see that.
 Yeah, that would be great.
 Yes, so we have a department bone tree,
 but we'll have to see about-
 We have new members in the board.
 Are you guys on the Monroe County Alert System?
 Do you get the phone calls?
 And I do, things like that.
 And I mean, I do, 'cause that would be something.
 If you wanna get them, I'm gonna tell you.
 Don't make me regret that.
 The middle of the night.
 Yes, the middle of the night, 3 a.m., yes.
 Bone tree with all those different trees.
 With all the phone numbers and such.
 But there've been a couple of emergency kinds of things
 where the board had to all of a sudden get together or-
 No, it's a good idea to have it, for sure.
 Other board member comments?
 I would like, in view of the previous public comments
 concerning the Futures Clinic, I have three things to say.
 The services that, first of all,
 the services that were being provided by the Futures Clinic
 in case someone's listening who doesn't know this,
 are currently being provided by the very granting agency,
 the Indiana Family Health Council,
 that was previously funding our Futures Clinic.
 And their clinic began operation within a short period
 following the closing here.
 A period of weeks.
 Yeah, so they're, excuse me.
 So those very services, as I had hoped,
 and I'm sure Aurora and everyone else,
 had hoped resumed in a fairly short period of time.
 That being said, Councilman Henry also mentioned
 a couple of points in previous comments to the board
 in a previous meeting while he was online.
 And I wanna try to address these really quickly
 in these very short comments.
 Individual employee performances
 will never be discussed in public.
 So in the after action report,
 there were redactions that were made prior
 to the release of the after action report
 because those were private matters.
 Names, performance, things are not going to be discussed
 because those are personnel matters and those are private.
 And he mentioned today the redaction, the after action report
 was released with redactions.
 Those redactions will remain.
 While the purpose was not to make a profit in this clinic,
 the clinic was requiring more county support
 beyond the grant because of declining patient income
 and ongoing billing issues related
 to the timely insurance claims being submitted or untimely,
 that will be more correct.
 This was a personnel issue and there were other
 performance factors that again will not be discussed
 that entered into the decision.
 I would like to remind the public
 that we did not actually close that clinic.
 That clinic was actually, the grant was removed
 at a time when the clinic was not performing well.
 And I'm talking about not performing well
 in patient numbers and in income production.
 And again, it's not a for-profit, it was never meant,
 that was not the purpose of it was to make a profit.
 But being good stewards of county money also was important
 and there was a trend to developing.
 And I'm just going to leave it with those three points.
 I don't want to, I wish there were,
 sometimes I wish there were more things
 that I could say concerning the clinic.
 I'm happy that I'm not happy about the criticism,
 I'm not happy about the clinic closing.
 And I am sorry that some employees feel
 that they were unfairly treated.
 I'm not convinced that that is the case,
 but nevertheless, the clinic is closed,
 but those services are being provided
 in the community at this time.
 Thank you.
 I would like to say something because it matches
 with what Steve just said.
 The requirement for cross-training that was mentioned
 has truly nothing to do with the family planning.
 The clinic, this was in Monroe County,
 all county, all department-wide initiatives.
 Cross-training was required of all employees
 because as we learned during COVID,
 you cannot run any business if several people are out
 and another person doesn't know how to answer a phone
 or how to take care of basic stuff.
 So that wasn't Laurie's decision or initiative.
 It wasn't a Title X.
 It had nothing to do with the Board of Health.
 That was a Monroe County government initiative.
 I also wanna say that we as a board,
 continually through this process,
 have and continue to support our public health administrator.
 She came on at a difficult time.
 She's been doing an exemplary job.
 Is she perfect?
 No, none of us are.
 Did she have some things to learn?
 Yes, well, that's what happens
 when you have a new employee in a job.
 But she's done an outstanding job.
 And I just wanted to say the board continues
 to be supportive of that.
 And on the third issue that I particularly
 have been repeatedly taken to task over,
 which is stating my position that board members
 should not directly interact with employees
 of the health department.
 This is because those employees
 do not report to the board of health.
 There is a chain command in place
 in every department in Monroe County.
 And the proper channel for concerns,
 if an employee has one, is their direct supervisor.
 And if that is not successful,
 the supervisor above that person.
 But it is not appropriate for board members.
 Even though the law does not prohibit that from happening,
 there is no reason for that to happen.
 So-- - It's also an internal--
 There's also a human resources department.
 Yeah, there are plenty of avenues
 for employees that feel they would like
 to discuss their performance
 or their job expectations or whatever.
 I'm sorry, I have a couple more things to say,
 but not on this topic.
 So does anyone else want to make a--
 I'll just throw into that,
 that while it may not be a regulation,
 it is good board governance
 that there is an invisible wall
 between the board and the department.
 And the one person who kind of sits between that
 is Lori and kind of maybe me, certainly Lori.
 She is the only one who can direct employees
 and can approve employees doing anything
 that a board member may request.
 That's just how it has to be
 because otherwise everything turns to crap.
 Thank you.
 Otherwise, every problem that develops,
 people don't like Lori and what she tells them,
 they go directly to somebody on the board.
 Yeah, afford governance.
 Thank you, that's exactly the phrase I would have used.
 Lisa, I think there is a lot of displaced anger from,
 I think there's anger at the board.
 I do think that, I think that's displaced to Lori unfairly.
 And we are behind you and support you
 and thank you for all that you do.
 Thank you.
 Couple of quick things.
 There have been some requests for board members
 to get their meeting packet information
 in the agenda earlier.
 I just wanna kind of from my perspective
 and then ask you all what your preference would be.
 We could, for example,
 for every month that we have a meeting,
 we could cut off folks contributing things like this report
 and this contract and blah, blah, blah.
 For example, on the Friday before our next Thursday,
 that would allow us to send you your board packet
 Friday or Monday, you'd have more time to read it.
 The downside of that would be any item coming in late
 would go until next month.
 Or if it's a contract and it's timely,
 we would have to have a special session.
 So everything is weighing.
 Additionally, we have tried to strike a balance
 between sending out the whole packet,
 what we thought was the whole packet too early.
 And then these things come in and you guys,
 instead of getting one mailing for a meeting,
 you got like five, oh, well, here it is.
 Oh, but then there's this and then there's this
 and believe me, I share your frustration.
 I am not sure how to resolve this,
 but I wanted to tell everybody, yeah, I hear you.
 Somebody can think of a great way to do this.
 We compromise and just make it three days
 before the next meeting rather than a week.
 So that you only delay one more day.
 That would give us a little more time to read them.
 We got it on like Monday or something, Monday.
 So you wanna get it Monday, all right.
 And then what happened when late breakers come in?
 Well, I would say, I mean, send it.
 You don't have to get it all at once, but you're right.
 A whole bunch of mailings would be good,
 but if we could count on getting the bulk of the stuff
 by the meeting and by the Monday prior
 to the Thursday meeting, then that it's something else
 that has to come in late, but it's easier to read one thing
 at this for three to all.
 That's what we'll shoot for then.
 It would reduce the confusion factor by a good deal.
 Okay, thank you.
 And then I just had a question.
 I don't know if Dave's still with us.
 Did we, and some of you might know.
 Yes.
 Regarding the Medical Reserve Corps,
 because this also came up at our meeting
 and I just wanted to check back.
 I know that we have been told
 we can't really do anything with the MRC.
 It has to do with liability and my understanding,
 and I could be wrong, is that the liability insurance
 can kick in as long as they're activated.
 And that may or may not be true,
 but it seems like for two years now anyway,
 we have had a non-functioning Medical Reserve Corps.
 And I think we've had several board meetings
 discussing this liability issue
 and I'm not sure it's resolved.
 And I would just, I'd like to take whatever steps we could
 to either get them going or to say,
 okay, we're not gonna have a Medical Reserve Corps
 because right now it feels like we're in limbo.
 Are we receiving federal dollars to have that MRC?
 I don't think so.
 How do we support it?
 Just from our general budget?
 I have not come across that, so I am not--
 So I think it's a federal program.
 It is a volunteer program.
 It's similar to volunteer, we have a staff person
 who kind of, I'm a member too.
 We have a staff person who coordinates it.
 Oh yes, but that, their salary is just part
 of the general fund of the person?
 Preparedness.
 It's unpreparedness.
 Right, yeah.
 The preparedness person did it.
 The funds which are being cut because of liability.
 Dave?
 Is he still there?
 Yes.
 Hi.
 So can you shed any light on what's going on
 with the liability for Medical Reserve Corps?
 I cannot.
 I have actually never heard of the Medical Reserve Corps.
 So I will check.
 Maybe Molly had been working on that.
 I'm not sure.
 Like simple events.
 Jeff.
 Jeff.
 Jeff was?
 Okay, yeah.
 Yeah, because it makes no sense for us
 to maintain this group of volunteers
 if we can't give them anything to do ever.
 And I think if we have another--
 It's kind of like a feel-good thing.
 Right?
 If we have another--
 They did stop a belief program last week.
 And we need to, you know,
 we need to use these volunteers.
 We need to have a working group
 that has liability insurance and the county says,
 okay, you can go out and do your work now.
 So we'd appreciate you checking on that.
 Will do.
 Thank you.
 Thank you.
 Anything else?
 Not too bad.
 We're only seven minutes over night
 when I was shooting for it.
 So it's o'clock.
 Do you have a motion to adjourn?
 I move the re-incorporation.
 I second.
 All those in favor?
 Aye. - Aye.
 Okay, if you could turn this off.
 Unplug us.
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